(689) Cost Analysis and Length of Stay for Patients With Paroxysmal Storming in Intracerebral Hemorrhage

Introduction: Paroxysmal Sympathetic Hyperactivity (PSH) involves sudden, intense activation of the sympathetic nervous system, causing acute fluctuations in vital signs, which can escalate into life-threatening conditions. Although extensively studied in traumatic brain injury (TBI), there is limited research on PSH in intracerebral hemorrhage (ICH) patients. PSH is associated with prolonged hospital and intensive care unit (ICU) stays, leading to increased healthcare costs and resource demands. This study aims to fill the knowledge gap by investigating the prevalence, risk factors, and clinical characteristics of PSH in ICH patients, and assessing its impact on length of stay (LOS) and overall costs, thereby providing insights to improve patient management and optimize resource use in this critical population.

Methods: We conducted a retrospective review of consecutive patients admitted to an academic center with ICH from May 1, 2020, to October 1, 2023. We compared baseline characteristics between patients with and without PSH. Univariate analyses assessed differences in length of stay and ICU length of stay between these groups. Additionally, we evaluated indirect and direct hospital costs associated with each patient's encounter to gain further insights into the financial implications.

Results: For ICU LOS, the non-PSH group (n=364) averaged 5.65 days, while the PSH group (n=14) averaged 24.57 days. For hospital LOS, the non-PSH group averaged 9.72 days, compared to the PSH group's 37.79 days. Cost data analysis revealed significant differences between the non-PSH and PSH groups across multiple cost categories. The PSH group had higher mean total charges ($731,111.79 vs. $171,523.83; p < 0.0001), total direct costs ($154,998.57 vs. $36,319.47; p < 0.0001), total indirect costs ($71,213.29 vs. $16,818.00; p < 0.0001), and total costs ($226,211.79 vs. $53,137.46; p < 0.0001) compared to the non-PSH group.

Conclusions: The data indicates that patients with PSH experience significantly longer ICU and hospital stays compared to those without PSH. This results in substantially higher hospital costs, underscoring the considerable financial impact of managing PSH in patients with intracerebral hemorrhage.